Our study has limitations common to most large-scale surveys. First, information on alcohol consumption, medical conditions, and other clinical characteristics was based on self-report and not confirmed by collateral informants. As a result, recall bias is a potential limitation. Second, general population surveys like the NESARC may fail to capture some individuals with AD because individuals with substance use disorders are less likely to live in households, the sampling frame of most general population surveys (Grant et al., 2003a). The NESARC, however, also sampled from shelters and group homes; this strategy increases the representation of individuals with AD within the sample and makes the underrepresentation of this population less likely. Because of this sampling strategy, NESARC estimates of prevalence, risk, comorbidity, and treatment-utilization behaviors are more likely to be representative of individuals with AD. Third, although the NESARC provides the most extensive assessment of psychiatric disorders among men and women with AD, some disorders such as obsessive-compulsive disorder were not assessed in this study. Fourth, the cross-sectional design of our study precludes examination of the causal relationship between AD and
